A recent General Surgery digest,
as sent to subscribers

Study Type: Prospective observational cohort study

Key Question: How does quality of life change in living liver donors during the first year after robotic donor hepatectomy, and what factors influence recovery?

Key Findings:

• Physical health domains (SF-36) dipped at 3 months but returned to baseline by 12 months; emotional well-being and energy improved beyond baseline from 6 months onward.
• Body image disturbance and depressive symptoms remained low throughout follow-up.
• Donor complications and early recipient mortality caused only transient dips in specific domains; recipient disease severity and graft type had no consistent effect on donor QoL.

Clinical Relevance: Supports adoption of unselected robotic donor hepatectomy programmes as offering favourable donor-centred recovery, relevant as UK transplant centres expand minimally invasive living donor liver surgery.

Limitations: Single-centre design without a comparator (open/laparoscopic) group limits causal attribution of outcomes specifically to the robotic approach.

Study Type: Single-centre RCT

Key Question: Does intraoperative NIRAF probe guidance (PTeye) improve parathyroid gland identification and preservation, and reduce hypoparathyroidism, compared with visual identification alone during total thyroidectomy?

Key Findings:

• PTeye increased mean parathyroid glands identified (3.81 vs 2.73, P<0.001) and glands preserved in situ (98.7% vs 87.0%, P=0.004); inadvertent parathyroidectomy fell from 20.8% to 5.2% (P=0.004).
• Transient hypoparathyroidism was markedly reduced with PTeye among junior surgeons (20.5% vs 55.2%, P<0.001), with no significant benefit for senior surgeons.
• Permanent hypoparathyroidism rates were similar between groups; low postoperative day-1 PTH was predicted by female sex, ≤2 glands preserved, and autotransplantation.

Clinical Relevance: NIRAF-guided identification could reduce transient hypocalcaemia and associated morbidity/readmissions in UK thyroid units, particularly benefiting training and less experienced operators.

Limitations: Single-centre design with small surgeon numbers limits generalisability and assessment of learning curve effects.

Study Type: Retrospective multicentre cohort study (international)

Key Question: Is auxiliary partial orthotopic liver transplantation (APOLT) safe and effective in children under 10 years with fulminant hepatic failure, particularly for enabling native liver regeneration and immunosuppression withdrawal?

Key Findings:

• Zero 90-day perioperative mortality; 25-year overall survival 97.6% (n=42).
• Native liver regeneration confirmed in 95% (38/40), with 80% of transplanted patients (76.2% intention-to-treat) successfully weaned off immunosuppression.
• Perioperative complications included hepatic artery thrombosis (7.1%), biliary strictures (7.1%), portal vein thrombosis (4.8%); 9.5% required retransplantation.

Clinical Relevance: Supports wider consideration of APOLT over standard orthotopic transplant in young children with FHF, offering excellent survival with the added benefit of avoiding lifelong immunosuppression—relevant to UK paediatric liver transplant centres (e.g., King's College Hospital) shaping practice guidance.

Limitations: Retrospective design with small sample size (n=42) from highly specialised centres limits generalisability and introduces selection bias.

Study Type: Multicentre retrospective cohort study (comparative analysis, international)

Key Question: Which machine preservation strategy best reduces biliary complications and improves survival in DCD liver transplantation, particularly in higher-risk (outside-benchmark) grafts?

Key Findings:

• Among 1538 perfused DCD livers (65% outside-benchmark), NRP+HOPE and NRP-alone were associated with significantly lower non-anastomotic stricture (NAS) rates (OR 0.20, 95% CI 0.08–0.57; OR 0.28, 95% CI 0.11–0.57), including in extended-criteria grafts.
• Back-to-base NMP had the highest NAS rate outside-benchmark (18%) versus upfront NMP (9%); neither differed significantly from static cold storage.
• Donor/preservation factors explained more variance in NAS risk than recipient factors (19% vs 3%); donor age independently increased NAS risk (OR 1.02 per year).

Clinical Relevance: Supports wider adoption of normothermic regional perfusion (with or without HOPE) in UK DCD liver retrieval pathways to expand safe organ utilisation and improve biliary outcomes, especially as NHSBT increasingly relies on DCD donors.

Limitations: Retrospective, non-randomised design with heterogeneous centre practices limits causal inference regarding preservation technique superiority.

Study Type: Prospective multicentre cohort study with propensity-matched historical controls

Key Question: Can an ERAS protocol improve perioperative outcomes in children undergoing complex lower urinary tract reconstruction without increasing complications?

Key Findings:

• Protocol adherence rose from a median of 8 to 16 of 20 elements (P<.001); length of stay fell from 8.0 to 5.3 days (P<.001).
• Postoperative opioid use decreased by 74% with no rise in maximum pain scores.
• Complication rate fell from 72.5% to 60.1% (P=.01), with no difference in 90-day ED visits, readmissions, or reoperations.

Clinical Relevance: Although paediatric-specific, this demonstrates ERAS principles (multimodal analgesia, standardised perioperative pathways) can safely reduce length of stay and opioid burden in complex reconstructive surgery, reinforcing the evidence base for ERAS adoption across NHS surgical specialties facing bed and opioid-stewardship pressures.

Limitations: Use of historical (non-contemporaneous) controls rather than randomisation limits causal inference and introduces potential confounding from secular trends in care.

Study Type: Diagnostic/prognostic model development and external validation study

Key Question: Can a deep learning model accurately detect surgical site infections (SSIs) from wound photographs to support telemedicine-based postoperative monitoring?

Key Findings:

• Convolutional neural network (InceptionV3-based) trained on 4,978 wound images achieved strong internal discrimination (AUC 0.91, 95% CI 0.88–0.93) with good calibration.
• On external validation (407 images, 95 patients), performance remained clinically useful but lower (AUC 0.82, 95% CI 0.75–0.90).
• Decision curve analysis demonstrated net clinical benefit, supporting potential use in automated triage.

Clinical Relevance: With NHS fast-track discharge pathways increasingly relying on remote wound monitoring, this model could help standardise SSI detection, reduce clinician workload, and expedite escalation of true infections.

Limitations: Performance dropped notably from internal to external validation, indicating limited generalisability across settings and populations before real-world clinical deployment.

Study Type: Unable to determine (no abstract text provided)

Key Question: Unable to determine (no abstract text provided)

Key Findings: Not available—no data provided in the abstract

Clinical Relevance: Based on the title alone, this likely concerns adherence to updated Commission on Cancer surgical margin/staging guidelines for melanoma, which would be relevant to UK surgeons via comparison with British Association of Dermatologists/NICE melanoma guidelines—but this cannot be confirmed without the full text.

Limitations: Cannot be assessed without abstract content. Please provide the full abstract text to generate an accurate structured summary.

Study Type: RCT (multicenter, PROBE design)

Key Question: Does intraoperative application of SI-449, a powdered cross-linked chondroitin sulfate barrier, reduce incisional adhesion formation after open rectal resection?

Key Findings:

• Adhesion incidence at second-look surgery (ileostomy closure) was significantly lower with SI-449 (26/58, 45%) vs control (56/60, 93%; P<.001).
• Adhesion severity and extent were also significantly reduced in the treatment group.
• No safety concerns identified; operability during application was rated good.

Clinical Relevance: Adhesion-related complications (obstruction, difficult reoperation) are a significant burden after open colorectal surgery, and this barrier offers a practical, easy-to-apply option for uneven pelvic/abdominal surfaces relevant to UK rectal cancer practice.

Limitations: Open-label intervention with blinded outcome assessment only, conducted solely in Japanese centres, limiting generalisability and introducing potential performance bias.